Physicians see broad, atypical symptoms among monkeypox patients

While large pustules are characteristic of monkeypox, patients infected amid the current outbreak have presented with a broad range of symptoms, physicians told The New York Times in an Aug. 26 report. 

Typically, monkeypox begins with flu-like symptoms, with a rash that develops a few days later. However, physicians have seen infected patients who don't ever develop a rash, as well as patients with pox or lesions as their only symptom. For some, lesions have looked like mosquito bites or ingrown hairs, rather than the large pustules characteristic of the infection. There have also been cases where patients experience confusion and seizures, severe eye infections and heart muscle inflammation. 

"We really are seeing a very, very wide range of presentation," Boghuma Titanji, MD, PhD, infectious disease physician at a clinic in Atlanta, told the Times.

Monkeypox is known to spread through sustained close contact, and emerging evidence has led researchers to believe the virus can be transmitted through sex itself. Other cases suggest even people with atypical or no symptoms can spread the virus. Earlier this month, researchers in France published a study saying they had detected monkeypox virus on samples collected as part of routine STI screening among asymptomatic men who have sex with men. Of 200 people who were asymptomatic for the disease, 13 samples were positive for the virus. Two of them later developed symptoms. 

The CDC on its "how it spreads" webpage says scientists are still researching "if the virus can be spread when someone has no symptoms," as well as whether it can be spread directly "through semen, vaginal fluids, urine or feces." 

"It's no longer correct to say it can't be transmitted asymptomatically," Dr. Chloe Orkin infectious disease physician at Queen Mary University of London, told the Times. "I think that it means our working model of how it's spread is incorrect."

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